The MetLife Market Survey of. October MetLife Mature Market Institute in conjunction with LifePlans, Inc.

Transcription

1 The MetLife Market Survey of Nursing Home & Assisted Living Costs October 2008 MetLife Mature Market Institute in conjunction with LifePlans, Inc.

2 The MetLife Mature Market Institute Established in 1997, the Mature Market Institute (MMI) is MetLife s center on aging and the 50+ market. MMI s groundbreaking research, gerontology expertise, national partnerships, and educational materials work to expand the knowledge and choices for those in, approaching, or caring for those in the mature market. MMI supports MetLife s long-standing commitment to identifying emerging issues and innovative solutions for the challenges of life. MetLife, a subsidiary of MetLife, Inc. (NYSE: MET), is celebrating 140 years and is a leading provider of insurance and financial services to individual and institutional customers. For more information about the MetLife Mature Market Institute, please visit their website at Contact us: MetLife Mature Market Institute 57 Greens Farms Road Westport, CT (203) / Fax (203) MatureMarketInstitute@MetLife.com LifePlans, Inc. LifePlans, Inc., a risk management and consulting firm, provides data analysis and information to the long-term care insurance industry. The firm works with insurers, the federal government, industry groups, and other organizations to conduct research that helps these groups monitor their business, understand industry trends, perform effective advocacy, and modify their strategic direction. LifePlans, Inc. 51 Sawyer Road, Suite 340 Waltham, MA (781) MetLife

3 Table of Contents Executive Summary Survey Changes 5 Overview 6 Nursing Homes 6 Assisted Living Communities 7 Methodology 10 Nursing Homes 10 Assisted Living Communities 11 Table of Nursing Home Costs 12 Table of Assisted Living Costs 19 Endnotes 26 3

4 The MetLife Market Survey of Nursing Home & Assisted living Costs October 2008 Executive Summary In 2002, the MetLife Mature Market Institute pioneered the collection and publication of national market survey data on nursing home and assisted living costs. Since then, as industry thought leaders, the Mature Market Institute has annually produced, updated, and released this market survey data. For the 2008 survey, daily private-pay rates for longterm (custodial) nursing home care were obtained for private and semi-private rooms in licensed facilities throughout the United States. Monthly private-pay base rates, which are defined as room and board and typically include at least two meals per day, housekeeping, and personal care assistance, were obtained for one-bedroom apartments or private rooms with private baths in assisted living communities. National average rates for a private room in a nursing home remained essentially unchanged from 2007, with national average rates for a semi-private room increasing modestly by 1.1%, from $189 daily or $68,985 annually in 2007, to $191 daily or $69,715 annually in National average assisted living rates increased by 2.1%, from $2,969 monthly or $35,628 annually in 2007, to $3,031 monthly or $36,372 annually in In 2008, Louisiana area (representing the state s non-metropolitan and non-suburban areas) had the lowest daily rates for a private room in a nursing home, averaging $127 per day. The Minnesota and Oklahoma areas had the lowest daily rates for a semi-private room in a nursing home, averaging $121 per day. The highest average daily rates for nursing homes came from Alaska Statewide, which came in at $577 for a private room and $566 for a semi-private room. For assisted living communities, North Dakota Statewide had the lowest average monthly base rate at $1,980, and Maine Southern Maine had the highest average monthly base rate at $4,708. 4

5 Summary of National Findings National Findings Nursing Homes Assisted Living Communities Private Room Semi-Private Room Rate Type Daily Daily Monthly 2008 Average Rate $212 $191 $3, Average Rate $213 $189 $2,969 $ Change 2007 to 2008 $1 +$2 +$62 % Change 2007 to % +1.1% +2.1% 2008 Median Rate $200 $178 $2, High Average Rate $577 $566 $4,708 Note: Costs vary by region and by the services included in the base rate costs. AK Statewide AK Statewide ME Southern Maine 2008 Low Average Rate $127 $121 $1,980 LA MN ND Statewide OK 2008 Survey Changes The MetLife Mature Market Institute market surveys have evolved over the years to provide the most complete information in a format that is easy to navigate. In 2008, the survey expanded its scope to provide additional rate information for the Rest of State to include areas outside the Metropolitan Statistical Areas (MSA) that are customarily measured. This addition not only provides market survey information that is more locally relevant, it allows for calculation of statewide averages in states where only MSA data were provided in prior years. The 2008 assisted living market data also include groupings of communities by the number of services which are included in the monthly base rate. The number of services included in a base rate can vary by community, and can significantly impact overall costs. Format changes for the 2008 survey include color coding: Nursing Homes Assisted Living Communities Also, rates are now listed in state-name alphabetical order, with their MSAs (where available) listed below the statewide summary information. 5

6 Overview Nursing home care and assisted living services represent adjoining levels of the care continuum. A nursing home is a facility which provides residents with a room, meals, skilled nursing care, and medical services. Nursing homes provide care to residents with chronic conditions requiring long-term nursing care or for those needing a shorter term recovery period after hospitalization. Typically, patients in long-term care facilities require assistance with multiple activities of daily living (bathing, dressing, eating, toileting, transferring in and out of chairs or beds, and continence), and/or have cognitive limitations due to Alzheimer s disease or another form of dementia. In the continuum of care, assisted living bridges the gap between home care and nursing homes. It provides services for those who are not able to live independently, but do not require the level of care provided by a nursing home. Residents of assisted living communities may need personal care assistance with meal preparation, activities of daily living (ADL), and household chores, and/or require supervision due to a cognitive impairment related to disorders such as Alzheimer s. This market survey contains daily rates for private and semi-private rooms in private pay nursing homes and monthly base rates for assisted living communities across the United States. Nursing Homes Admission to a nursing home could be for short-term rehabilitation services; however, for many Americans, the move to a nursing home is a permanent one. The nursing home resident may have a chronic condition or a cognitive impairment that prevents him or her from living independently and requires skilled nursing services. Nursing homes provide a secure environment and an array of services to meet the physical, medical, and social needs of their residents. Services provided at nursing homes typically include: Room and board Medication management Personal care (assistance with ADLs) Social and recreational activities According to the U.S. Census Bureau, in 2007, 68% of nursing home residents were women, and only 14% of all residents were under the age of 65. The median age of residents was 83.1 years. 1 MetLife s 2008 Market Survey found that 81% of all nursing homes surveyed are freestanding facilities, and 17% have an associated assisted living unit or wing. Thirty percent of the nursing homes surveyed have separate Alzheimer s units or wings. The national average daily rate for a private room in an Alzheimer s unit or wing is $219 ($79,935 annually). The national average daily rate for a semi-private room in an Alzheimer s unit or wing is $198 ($72,270 annually). 6

7 Assisted Living Communities Assisted living communities provide housing for those who need help in day-to-day living, but who do not need the round-the-clock skilled care found in nursing homes. Many communities have nurses on staff and provide healthcare monitoring. It is currently estimated that more than 900,000 Americans live in approximately 39,500 assisted living residences in the United States. 2 The average age of an assisted living resident is 85 years old, 3 and the average length of stay in assisted living is approximately 21 months. 4 Most assisted living communities create an individual plan for each resident that details the services required. This plan is usually updated regularly to ensure that residents receive proper care as their conditions change. While the term assisted living is used in many parts of the country, other common terms include: Residential care Personal care Average Rate in Alzheimer s Unit or Wing Private Room Adult congregate living care Semi-Private Room $219 Daily $198 Daily $79,935 $72,270 Annually Annually Board and care Domiciliary care Adult living facility Supported care Enhanced care Community-based retirement facility Adult foster care Adult homes Sheltered housing Retirement residence Service-enriched housing Oversight of assisted living communities is primarily in the hands of state governments rather than under federal regulation. In 2007, several states strengthened existing standards or implemented new standards for communities with residents with Alzheimer s disease or other forms of dementia. Some states increased training requirements for staff or added disclosure requirements to prospective residents. Depending upon their chosen level of service, residents in assisted living communities may have the following services offered: Care management and monitoring Help with activities of daily living Housekeeping and laundry Medication management Recreational activities Security Transportation Two or more meals per day 7

8 Base Rates As noted in the 2007 study, fees for additional services can vary considerably by community size. Regardless of size, base rate fees often cover only some of the total costs of needed assisted living services. Communities will vary on the number of services that are included in their base rate. The MetLife market survey reports on monthly base rates, therefore it is important to know what services are included when choosing a community. Additional services may be offered on an a la carte basis, thus impacting the overall cost of care once someone actually resides in the community. As residents age, they may experience a reduction in their capacities and require additional services over time that were not required when they entered the community. In the 2008 survey, information on 12 services provided by assisted living communities was collected and analyzed based on the number of services covered in the monthly base rate, or services which are available onsite at the community. Communities were first categorized by the number of services included in the base rate. Communities that include 5 or fewer services in their base rate were characterized as basic, those that provide 6 to 9 services in their base rate were characterized as standard, and those including 10 or more services in the base rate were considered to be inclusive. Of those surveyed, 22% of communities were in the basic category, 59% were in the standard category, and 19% were in the inclusive category. Even though communities in the same category offered the same number of services, they often did not offer the same services in their base cost, with some offering more costly services in their base rate in comparison to others. For example, the average monthly rate for providing assistance with activities of daily living (ADL) not included in the base rate is $386. The average monthly rate for providing assistance with instrumental activities of daily living (IADL), such as medication management, not included in the base rate is $327. Average Additional Monthly Rates for a Service Not Included in Base Rate Activities of Daily Living (ADL) $386 Instrumental Activities of Daily Living (IADL) $327 Monthly base rate costs increase as more services are included: communities in the basic category cost an average of $2,873, while those in the standard category have an average base cost of $2,985, a 3.9% increase. Communities in the inclusive category have an average base cost of $3,354, a 12.4% increase over the standard category, and a 16.7% increase over the basic category. 8

9 Base Rate $8,000 $7,000 $6,000 $5,000 Monthly Base Rate Costs for Assisted Living by Number of Services Included $7,448 $7,100 $7,500 max which may have a significant financial impact on them. With this in mind, consumers and financial advisors should consider carefully when making comparisons, and be especially mindful to gather information about services included in the monthly base cost and cost of services not included. When faced with paying thousands of dollars each month for care which will not be covered by Medicare, even a few dollars in lowered costs is attractive. However, it is in their best interests to make comparisons on total potential cost for equivalent levels of service, and not simply on monthly base rates. $4,000 $3,000 $2,000 $1,000 $0 $2,873 average $838 Basic (for 5 Services or less) 22% $2,985 average $1,000 Standard (for 6 to 9 Services) 59% $3,354 average $1,100 Inclusive (for 10 Services or more) 19% min Some communities, particularly continuing care retirement communities (CCRC) offering multiple levels of care, also charge a one-time entrance fee ranging from $60,000 to $120,000, 5 and have additional fees for items such as meal delivery to living quarters, dementia care, or extra transportation services. A growing number of states have begun covering assisted living costs for those low-income individuals who qualify through Medicaid waiver programs, although most residents pay privately or through a long-term care insurance policy. Communities in the same category often vary considerably in regard to base costs, as well as the costs for services not included in the base cost. The figure above illustrates the service categories, average base cost for the category, minimum and maximum monthly base costs in the category, and percentage of communities that fall into each category. Consumers are often faced with a varied array of communities and services in a local area, and must make comparisons and decisions about communities Fifty-two percent of the assisted living facilities surveyed provide Alzheimer s and dementia care for residents, half of which charge an additional fee for this service. The national average monthly base rate for Alzheimer s and dementia care is $4,267 ($51,204 annually). Average Base Rate for Alzheimer s and Dementia Care $4,267 Monthly $51,204 Annually 9

10 Methodology This survey of nursing homes and assisted living communities of all 50 states and the District of Columbia was conducted by telephone in September 2008, by LifePlans, Inc., for the MetLife Mature Market Institute. The states were divided into three groups according to population under 3 million, 3 to 10 million, and over 10 million. These groupings were determined using data from the 2000 U.S. Census. The cities/areas surveyed within the states were chosen on the basis of population and the ability to obtain a geographically balanced sampling. For the areas, a sample of facilities identified in the state but not already included in the Metropolitan Statistical Area (MSA) sample were contacted. In each city/area, a minimum of 10 nursing homes/assisted living communities, or 15%, whichever was greater, were surveyed. As with any survey research, readers should exercise caution when generalizing results in this market survey. The survey should be used as a guide to assist individuals in making long-term care decisions. Nursing Home Methodology Survey callers to the nursing homes requested to speak with the Director of Admissions or a comparable professional. Nursing homes were called at random within each area and were required to meet the following criteria: Must be licensed Must provide skilled and custodial care Most offer a private pay rate for long-term care (custodial care), not the Medicare or Medicaid reimbursed rate Of the nursing homes that met the criteria, private pay rates were obtained for both private and semi-private rooms. If the nursing home did not meet the criteria, another would be called until a minimum of 10 nursing homes or 15% of the homes in that city/area were obtained. Data from 1,862 nursing homes are included in the tabulation. 10

11 Assisted Living Methodology Callers to the assisted living communities asked for the Director of Admissions or a comparable professional. Facilities were called at random and had to meet the following criteria: Must be licensed according to each state s standards for licensure Must provide personal care assistance Must provide private pay rate Of those that met the criteria, monthly base rates were obtained for a one-bedroom apartment with a private bath or a private room with a private bath. The facilities were also grouped by the number of services included in the monthly base rate. Data from 1,518 assisted living communities, ranging in size from 3 to 344 beds, were included in the sample; the average number of beds per facility was 60 beds. 11

12 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average Alabama (AL) Birmingham Montgomery Alaska (AK) Arizona (AZ) Phoenix Tucson Arkansas (AR) Little Rock California (CA) Los Angeles San Diego San Francisco Colorado (CO) Denver Colorado Springs Connecticut (CT) Hartford Stamford Area Washington (DC) Delaware (DE) Wilmington All & & $144 $410 $130 $130 $142 $100 $113 $100 $135 $135 $157 $195 $157 $143 $152 $163 $143 $209 $209 $285 $271 $200 $170 $188 $170 $270 $178 $270 $180 $875 $198 $195 $153 $153 $375 $375 $251 $208 $202 $194 $208 $420 $420 $417 $375 $401 $427 $245 $427 $161 $186 $566 $171 $168 $168 $173 $129 $123 $201 $183 $195 $192 $180 $179 $182 $179 $335 $321 $364 $326 $269 $221 $217 $224 $132 $168 $132 $410 $155 $170 $165 $155 $105 $105 $165 $165 $190 $148 $166 $148 $289 $330 $210 $135 $216 $135 $208 $187 $208 $190 $875 $355 $355 $226 $299 $260 $226 $260 $462 $278 $350 $462 $299 $285 $220 $285 $235 $447 $445 $447 $409 $432 $427 $280 $427 $167 $169 $187 $157 $577 $214 $222 $204 $215 $152 $170 $142 $249 $198 $240 $344 $226 $200 $200 $205 $198 $362 $359 $394 $346 $295 $239 $246 $235 12

13 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average Florida (FL) Jacksonville Orlando Miami Georgia (GA) Marietta Area Atlanta Hawaii (HI) Honolulu Idaho (ID) Boise Illinois (IL) Des Plaines Area Chicago Peoria Indiana (IN) Indianapolis Fort Wayne Iowa (IA) Des Moines $90 $155 $165 $90 $114 $114 $220 $225 $220 $124 $175 $124 $88 $133 $114 $107 $88 $117 $120 $145 $117 $110 $110 $275 $209 $216 $275 $222 $209 $198 $209 $202 $484 $320 $484 $240 $240 $210 $280 $280 $220 $206 $195 $202 $182 $202 $198 $183 $183 $152 $191 $180 $196 $199 $189 $159 $165 $165 $153 $299 $257 $334 $180 $198 $171 $159 $204 $156 $148 $143 $157 $151 $169 $154 $132 $148 $124 $105 $158 $194 $145 $105 $122 $130 $122 $220 $225 $220 $137 $180 $137 $108 $196 $120 $121 $108 $130 $130 $173 $147 $118 $135 $118 $396 $230 $278 $295 $396 $234 $218 $234 $218 $515 $325 $515 $210 $387 $350 $387 $300 $344 $310 $344 $244 $462 $193 $462 $218 $192 $224 $220 $228 $171 $178 $185 $161 $306 $277 $342 $192 $215 $181 $202 $263 $168 $210 $178 $195 $187 $213 $192 $156 $159 $155 13

14 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average Kansas (KS) Wichita Kentucky (KY) Louisville Lexington Louisiana (LA) Baton Rouge Shreveport Area Maine (ME) Southern ME Maryland (MD) Silver Spring Baltimore Massachusetts (MA) Worcester Boston Michigan (MI) Detroit Grand Rapids $114 $114 $136 $165 $136 $90 $117 $115 $90 $127 $205 $127 $165 $205 $197 $165 $245 $235 $111 $111 $180 $168 $205 $176 $205 $225 $196 $225 $219 $170 $142 $170 $315 $315 $289 $273 $273 $267 $262 $399 $399 $345 $348 $246 $206 $246 $238 $136 $144 $131 $168 $178 $177 $127 $127 $132 $231 $246 $224 $218 $228 $222 $211 $286 $297 $282 $282 $195 $167 $211 $200 $121 $131 $121 $145 $180 $177 $145 $90 $117 $115 $90 $201 $215 $201 $167 $220 $210 $167 $173 $255 $173 $111 $111 $205 $170 $231 $200 $231 $240 $234 $240 $225 $156 $156 $148 $334 $334 $311 $523 $420 $276 $523 $395 $330 $370 $395 $263 $213 $263 $249 $147 $159 $141 $184 $204 $197 $169 $132 $135 $137 $127 $255 $283 $241 $248 $260 $243 $242 $302 $295 $309 $302 $203 $169 $234 $210 14

15 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average Minnesota (MN) Minneapolis/St. Paul Rochester Area Mississippi (MS) Jackson Missouri (MO) Saint Louis Kansas City Montana (MT) Billings Nebraska (NE) Omaha Nevada (NV) Las Vegas New Hampshire (NH) Manchester New Jersey (NJ) Cherry Hill Area Bridgewater Area 551 & $100 $101 $109 $100 $145 $163 $145 $95 $128 $115 $95 $154 $102 $117 $102 $157 $181 $157 $190 $220 $190 $200 $235 $220 $200 $177 $177 $174 $155 $215 $199 $215 $179 $179 $147 $154 $182 $175 $182 $217 $205 $217 $293 $280 $293 $305 $305 $288 $305 $127 $138 $131 $121 $176 $175 $177 $131 $145 $133 $122 $163 $166 $162 $144 $178 $127 $189 $192 $188 $247 $249 $246 $259 $275 $259 $101 $101 $112 $110 $154 $169 $154 $100 $130 $120 $100 $135 $135 $110 $147 $110 $175 $185 $175 $190 $235 $190 $225 $245 $245 $225 $375 $242 $375 $173 $230 $204 $230 $255 $255 $180 $176 $238 $190 $238 $259 $259 $158 $370 $370 $265 $330 $309 $330 $515 $350 $309 $515 $149 $168 $135 $184 $180 $186 $147 $175 $144 $134 $174 $177 $172 $158 $202 $138 $213 $226 $206 $266 $265 $266 $287 $302 $277 $286 15

16 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average New Mexico (NM) Albuquerque New York (NY) New York Syracuse Rochester North Carolina (NC) Raleigh/Durham Charlotte North Dakota (ND) Fargo Area Ohio (OH) Columbus Cleveland Cincinnati Oklahoma (OK) Oklahoma City Tulsa Oregon (OR) Portland Eugene & $118 $118 $197 $255 $225 $197 $136 $136 $110 $110 $115 $130 $168 $165 $135 $130 $100 $103 $120 $100 $116 $190 $189 $116 $210 $180 $210 $450 $450 $323 $329 $380 $249 $249 $208 $216 $170 $170 $147 $295 $218 $285 $295 $213 $292 $292 $230 $158 $169 $153 $306 $355 $282 $295 $296 $173 $174 $182 $169 $132 $136 $131 $186 $184 $198 $199 $174 $126 $131 $121 $205 $210 $210 $199 $174 $210 $265 $210 $170 $100 $120 $100 $148 $172 $175 $148 $105 $115 $105 $116 $200 $195 $116 $416 $246 $416 $460 $460 $323 $339 $390 $324 $324 $230 $239 $344 $344 $314 $266 $314 $295 $236 $260 $206 $260 $200 $403 $260 $292 $403 $189 $197 $185 $314 $361 $287 $309 $305 $192 $205 $196 $182 $154 $148 $203 $203 $215 $216 $191 $153 $161 $173 $231 $228 $228 $233 16

17 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average Pennsylvania (PA) Pittsburgh Scranton Philadelphia Rhode Island (RI) Providence South Carolina (SC) Columbia Charleston South Dakota (SD) Rapid City Area Tennessee (TN) Nashville Memphis Texas (TX) Dallas/Ft. Worth Houston Austin Utah (UT) Salt Lake City & $168 $196 $175 $215 $168 $205 $135 $143 $135 $136 $153 $115 $141 $115 $90 $90 $98 $100 $99 $135 $341 $318 $225 $275 $341 $276 $260 $276 $225 $194 $225 $189 $189 $189 $178 $205 $205 $180 $178 $193 $193 $147 $176 $200 $168 $200 $228 $249 $200 $242 $224 $225 $225 $224 $164 $167 $169 $155 $175 $145 $158 $177 $157 $151 $130 $129 $134 $129 $128 $149 $153 $146 $165 $215 $177 $165 $170 $220 $138 $138 $138 $169 $138 $120 $120 $105 $148 $120 $137 $105 $143 $143 $394 $394 $237 $325 $328 $298 $275 $298 $215 $214 $214 $187 $240 $240 $223 $200 $235 $206 $235 $227 $232 $299 $260 $299 $243 $269 $207 $256 $245 $246 $247 $246 $183 $183 $188 $180 $169 $190 $158 $172 $191 $170 $161 $177 $188 $180 $167 $172 $192 $187 $195 17

18 Nursing Home Costs 2008 First 3 Zip Code Semi-Private Room Private Room State Numbers Low High Average Low High Average Vermont (VT) Virginia (VA) Alexandria Area Richmond Area Washington (WA) Seattle Spokane West Virginia (WV) Charleston Area Wisconsin (WI) Milwaukee Madison Area Wyoming (WY) National Average All 222 & & & 537 All $185 $193 $145 $161 $190 $193 $161 $116 $116 $145 $173 $174 $145 $279 $282 $282 $218 $266 $307 $307 $255 $226 $224 $226 $285 $285 $272 $217 $211 $231 $182 $226 $175 $167 $219 $243 $215 $209 $193 $192 $193 $196 $214 $207 $183 $174 $191 $200 $145 $214 $155 $145 $167 $225 $203 $167 $116 $165 $116 $155 $185 $179 $155 $312 $308 $308 $260 $331 $331 $285 $258 $237 $235 $237 $290 $285 $290 $247 $262 $248 $202 $258 $201 $178 $238 $275 $232 $223 $203 $201 $204 $216 $238 $231 $198 $187 $212 18

19 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average Alabama (AL) $1,250 $3,700 $2,425 Birmingham 352 $1,750 $3,700 $2,912 Montgomery 361 $2,075 $3,500 $2,573 $1,250 $3,500 $2,202 Alaska (AK) All $2,240 $6,800 $4,645 Arizona (AZ) $1,545 $5,200 $2,947 Phoenix 850 $1,650 $4,000 $2,751 Tucson 857 $2,260 $4,000 $3,157 $1,545 $5,200 $2,920 Arkansas (AR) $1,200 $5,000 $2,289 Little Rock Area 720 & 722 $1,300 $5,000 $2,675 $1,200 $3,400 $2,134 California (CA) $1,300 $6,600 $3,132 Los Angeles 900 $1,300 $3,000 $2,235 San Diego 921 $1,500 $5,000 $2,538 San Francisco 940 & 941 $2,000 $5,670 $3,669 $1,750 $6,600 $3,384 Colorado (CO) $1,512 $5,025 $3,121 Denver 802 $1,512 $3,200 $2,513 Colorado Springs 809 $2,500 $3,900 $3,329 $1,578 $5,025 $3,372 Connecticut (CT) $2,700 $7,500 $4,286 Hartford Area 060 & 061 $3,057 $5,060 $4,146 Stamford Area $2,910 $5,500 $4,403 $2,700 $7,500 $4,303 Washington (DC) 200 $2,000 $6,000 $4,414 Delaware (DE) $2,650 $5,640 $4,053 Wilmington 198 $3,400 $5,640 $4,410 $2,650 $5,191 $3,638 19

20 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average Florida (FL) $1,000 $4,800 $2,748 Jacksonville 322 $1,800 $3,925 $2,988 Orlando 328 $1,000 $3,850 $2,135 Miami 331 $2,000 $4,263 $2,936 $1,200 $4,800 $2,812 Georgia (GA) $1,850 $3,600 $2,732 Alpharetta 300 $2,250 $3,600 $2,861 Atlanta 303 $1,850 $3,600 $2,738 $1,900 $3,600 $2,642 Hawaii (HI) All $2,454 $5,500 $3,566 Idaho (ID) $2,098 $3,800 $2,847 Boise 837 $2,468 $3,800 $3,200 $2,098 $3,450 $2,591 Illinois (IL) $1,500 $6,200 $3,444 Highland Park Area 600 $2,500 $6,200 $4,268 Chicago 606 $2,200 $4,000 $2,939 Peoria Area $1,500 $4,300 $2,806 $2,165 $5,700 $3,506 Indiana (IN) $1,500 $4,650 $2,573 Indianapolis 462 $1,650 $3,885 $2,448 Fort Wayne Area $1,600 $3,200 $2,335 $1,500 $4,650 $2,758 Iowa (IA) $1,400 $3,300 $2,424 Des Moines Area $1,400 $3,300 $2,550 $1,824 $2,845 $2,344 20

21 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average Kansas (KS) $990 $5,200 $2,736 Wichita 672 $1,790 $5,200 $3,031 $990 $3,900 $2,580 Kentucky (KY) $1,325 $5,770 $2,831 Louisville 402 $2,645 $5,770 $3,579 Lexington Area $2,200 $3,990 $2,884 $1,325 $2,900 $2,282 Louisiana (LA) $1,500 $3,800 $2,318 Baton Rouge 708 $1,650 $3,800 $2,480 Shreveport Area 711 $1,700 $2,900 $2,338 $1,500 $3,100 $2,266 Maine (ME) $1,650 $7,448 $4,571 Southern ME 040 & 041 $3,300 $5,612 $4,708 $1,650 $7,448 $4,451 Maryland (MD) $1,100 $6,700 $3,659 Silver Spring 209 $2,454 $5,400 $4,316 Baltimore 212 $1,100 $4,764 $2,818 $1,800 $6,700 $3,775 Massachusetts (MA) $2,700 $7,100 $4,192 Worcester Area $3,300 $5,400 $4,145 Boston 021 $2,724 $6,275 $4,143 $2,700 $7,100 $4,240 Michigan (MI) $1,485 $4,290 $2,943 Detroit Area $2,050 $4,200 $3,218 Grand Rapids 495 $1,485 $3,390 $2,485 $2,200 $4,290 $2,942 21

22 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average Minnesota (MN) $838 $4,550 $2,524 Minneapolis/St. Paul 551 & 554 $1,550 $4,550 $2,871 Rochester Area 559 $1,200 $4,290 $2,489 $838 $3,000 $2,179 Mississippi (MS) $1,150 $5,700 $2,541 Jackson Area 390 & 391 $1,150 $5,700 $2,743 $1,500 $3,500 $2,375 Missouri (MO) $1,400 $4,522 $2,628 Saint Louis 631 $1,400 $4,410 $3,071 Kansas City Area 640 & 641 $1,564 $4,522 $2,444 $1,500 $4,195 $2,474 Montana (MT) $1,846 $4,150 $2,790 Billings 590 & 591 $2,700 $4,150 $3,245 $1,846 $3,500 $2,576 Nebraska (NE) $1,010 $4,080 $2,407 Omaha 681 $1,010 $4,080 $2,296 $1,611 $3,210 $2,530 Nevada (NV) $1,000 $4,850 $2,611 Las Vegas 891 $1,600 $3,600 $2,255 $1,000 $4,850 $2,776 New Hampshire (NH) $1,500 $6,720 $3,732 Manchester Area 030 & 031 $1,500 $6,720 $3,858 $2,250 $4,500 $3,516 New Jersey (NJ) $2,766 $6,870 $4,009 Cherry Hill Area 080 & 081 $2,766 $3,990 $3,259 Bridgewater Area $3,300 $4,514 $4,079 $3,180 $6,870 $4,356 22

23 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average New Mexico (NM) $1,575 $4,600 $2,772 Albuquerque 871 $1,631 $4,358 $2,805 $1,575 $4,600 $2,730 New York (NY) $1,125 $6,250 $3,362 New York $1,125 $6,250 $4,146 Syracuse $2,000 $4,500 $3,234 Rochester $2,299 $4,395 $3,081 $1,400 $5,370 $3,164 North Carolina (NC) $1,000 $4,175 $2,988 Raleigh/Durham 276 & 277 $2,500 $3,985 $3,269 Charlotte 282 $1,000 $4,175 $2,985 $1,900 $3,770 $2,891 North Dakota (ND) All $1,200 $3,295 $1,980 Ohio (OH) $1,650 $5,340 $2,987 Columbus Area $2,600 $5,340 $3,580 Cleveland 441 $2,000 $5,280 $3,139 Cincinnati 452 $2,100 $4,365 $2,869 $1,650 $3,400 $2,720 Oklahoma (OK) $1,450 $3,895 $2,346 Oklahoma City 731 $1,450 $3,895 $2,415 Tulsa 741 $1,830 $3,300 $2,600 $1,750 $2,950 $2,214 Oregon (OR) $1,500 $4,500 $2,827 Portland 972 $2,350 $4,500 $3,044 Eugene 974 $1,500 $3,795 $2,885 $1,800 $3,545 $2,619 23

24 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average Pennsylvania (PA) $1,400 $4,200 $2,846 Pittsburgh 152 $2,370 $3,450 $2,868 Scranton Area $1,400 $3,510 $2,494 Philadelphia Area 190 & 191 $1,600 $4,200 $3,098 $1,510 $4,200 $2,896 Rhode Island (RI) $1,400 $5,624 $3,319 Providence 028 & 029 $2,000 $4,300 $3,318 $1,400 $5,624 $3,320 South Carolina (SC) $1,100 $4,100 $2,726 Columbia Area $1,100 $3,850 $2,397 Charleston 294 $2,450 $4,100 $2,951 $1,650 $3,500 $2,766 South Dakota (SD) $1,680 $3,000 $2,341 Rapid City Area 577 $1,900 $3,000 $2,622 $1,680 $2,867 $2,194 Tennessee (TN) $1,575 $4,800 $2,807 Nashville Area 371 & 372 $1,575 $4,800 $3,099 Memphis 381 $2,200 $4,110 $3,015 $1,700 $3,595 $2,513 Texas (TX) $1,230 $5,595 $2,882 Dallas/Fort Worth 752 & 761 $1,700 $4,475 $2,849 Houston 770 $2,100 $3,990 $2,868 Austin 787 $3,000 $4,950 $3,649 $1,230 $5,595 $2,613 Utah (UT) $1,500 $3,450 $2,425 Salt Lake City 841 $1,936 $3,450 $2,428 $1,500 $3,100 $2,423 24

25 Assisted Living Costs 2008 First 3 Zip Code Assisted Living Base Rate State Numbers Low High Average Vermont (VT) All $3,300 $7,500 $4,375 Virginia (VA) $1,900 $5,800 $3,651 Northern Virginia $2,500 $5,800 $3,709 Richmond 232 $1,900 $4,300 $3,357 $2,040 $5,685 $3,734 Washington (WA) $1,900 $4,500 $2,799 Seattle 981 $1,900 $3,900 $2,965 Spokane 992 $1,900 $3,500 $2,445 $1,900 $4,500 $2,893 West Virginia (WV) All $2,500 $3,655 $2,933 Wisconsin (WI) $2,340 $4,500 $3,208 Milwaukee 532 $2,625 $4,500 $3,428 Madison 537 $2,795 $4,398 $3,224 $2,340 $4,500 $3,102 Wyoming (WY) All $1,575 $3,995 $2,741 National Average $3,031 25

26 Endnotes U.S. Census Bureau, American Community Survey, Characteristics of the Group Quarters Population by Group Quarters Type, American Association of Homes and Services for Aging, Aging Services: The Facts at National Center for Assisted Living, American Association of Homes and Services for the Aging, Assisted Living Federation of America, American Senior s Housing Association, and National Investment Center for the Seniors Housing & Care Industry, 2006 Overview of Assisted Living in Assisted Living Resident Profile at American Senior s Housing Association, National Investment Center for the Seniors Housing & Care Industry, and the American Association of Homes and Services for the Aging, 2008 The State of Seniors Housing. American Association of Homes and Services for Aging, Aging Services: The Facts at 26

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28 Variable and Long-Term Care Products are: Not a Deposit Or Other Obligation Of Bank Not FDIC-Insured Not Insured By Any Federal Government Agency Only Variable Annuity Products: Not Guaranteed By Any Bank Or Credit Union May Go Down In Value Only Long-Term Care Products: Not Issued, Guaranteed Or Underwritten By Bank Or FDIC Not A Condition To The Provision Or Term Of Any Banking Service Or Activity Policy Is An Obligation Of The Issuing Insurance Company 2008 Metropolitan Life Insurance Company 200 Park Avenue New York, NY MMI00095(1008) L (exp1210)